Dr. Ghaboussioffline

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  • Dr. Ghaboussi added 3 new photos in the group O-Club Chatroom 1 month, 3 weeks ago

    OH NO! This patient came in today with a #13 broken off at the gumline and a visable vertical fracture.
    Replacing the tooth as soon as possible is a priority for her so we discussed the +’s and -‘S of same day implants. She decided that she wanted the tooth extracted and an implant placed today, and that is exactly what we did.
    I’ll measure the width of the tooth on the x-ray and plan for a larger diameter implant.
    We remove the tooth as atraumatically as possible and spend time to remove any tissue/PDL from the socket.
    Then I use an osteotomy drill to create the correct space for the implant.
    If there is a significant amount of space on the buccal/lingual we will pack bone into the socket prior to inserting the implant.
    For anterior teeth the osteotomy will usually need to be made slightly to the lingual.
    I think this is a great service that patients really appreciate.

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    • Hi Doctor,
      Very nice placement of the implant after extraction. This is definitely a practice builder and saves the patient time and multiple visits. We are also recommending immediate load of the implant body if certain baseline values are achieved, e.g. 50+ final torquing and an ISQ value of 65+. These are safety measures that have been used to load the implant with a provional restoration.

      • Thanks Dr Jim. I suspect that it would have been fine to immediate load. I have to admit that it always makes me a little nervous to do immediate loading. When we do, I always document that I explain to the patient that if we “Put a tooth on right away” there may be complications and may have to start over. It makes me feel a little less tense because I don’t have a way to check the ISQ. I try to be conservative with my immediate placements as I had a bad experience with a patient that was trying to open beer bottles with his healing abutment…

        • Yes it is safer to second stage it if you do not evaluate the implant with an ISQ measurement. Also, bone level implants are for the most part designed for staging because final bone stabilty and integration takes 3-6 months. Nevertheless you did a great service for this patient. Socket grafting would have added an additional 4 months!